Cannabis and Opioids Are Unlikely Partners in Harm Reduction for Painkillers and Opioid Addiction Risk

Yet another way that cannabis is fighting the opioid epidemic: cannabis and opioids can work together to reduce pain, meaning lower doses for the addictive opioid prescription.

First, the sobering statistics: according to the National Institute on Drug Abuse, between 2007 and 2017, overdose deaths related to the use of opioids skyrocketed; rising from a little over 15,000 deaths nationwide, to close to 50,000. Even more terrifying is the jump in deaths associated with Fentanyl: for the same time frame, these went from a few thousand per year to roughly 30,000! Cannabis has been replacing opioids in many legal states, but for some patients, it’s not enough. Recent studies, however, show that cannabis and opioids can work together!

On average 115 people die in the U.S every day from an opioid overdose. Approximately 80 percent of people with a heroin addiction started out with a prescription for an opiate for pain relief. Over the course of the prescription, the essential characteristics of the drug led to abuse and dependency. It’s estimated that anywhere from 21 to 29 percent of people who receive a prescription for opioids, will abuse them.

These statistics are shaking the country. As the opioid crisis increasingly takes over headlines, everyone is looking for answers. Cannabis may just be what the doctor ordered, at least according to the latest evidence coming out of Columbia University. It’s well known that cannabis is a powerful source of pain relief, but it may also work synergistically with opioids to enhance the action of the latter. This would be lower doses of opioids and less risk of addiction.

The Complicated Relationship Between Cannabis, Opioids and the CB1 Receptor

Everyone has an endocannabinoid system. It is a network of receptors and chemical messengers, such as anandamide, that are located in almost every part of your body. This network is responsible for regulating pain, digestion, memory, the immune system, inflammation, and mood. There are two primary receptors, CB1 and CB2. The endocannabinoid system works to fight off infection, to trigger pain relief, to produce an anti-inflammatory response, as well as maintain homeostasis.

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The chemical compounds in cannabis, such as THC and CBD, interact with this system in much the same way. The many cannabinoids each have a unique role in turning these receptors on or off, to mimic the chemicals produced by our own bodies. Of primary concern for pain relief is THC’s unique relationship with the CB1 receptor, located mainly within our brains. Like a hand fits into a glove, THC fits perfectly into this receptor. Opioids, while intimately linked to our opioid receptors, also interact with the endocannabinoid system, through the CB1 receptor. Their relationship to one another is interesting, to say the least. Cannabis and opioids can work synergistically.

In early 2018, researchers published the results of a study exploring the relationship between opioids, cannabis and CB1 receptors. The team of researchers gave participants different doses of cannabis, oxycodone, or some combination of the two, then subjected to them Cold-Pressor Test (holding their hands in a bucket of cold water). The results are enough to make many ask, is there a place for cannabis alongside treatment with prescription opioids?

This double-blind, placebo-controlled, and first of its kind, study determined that cannabis improved the pain alleviation of oxycodone. Although the optimal dose of oxycodone by itself was 5 mg, this dose could be halved if participants were also given cannabis. Interestingly, by itself, neither cannabis nor the half dose of oxycodone was enough to reduce the experience of pain, but together they had a similar effect as an entire dose (5mg) of an opioid.

The Role of Cannabis in the Opioid Crisis

Some scientists believe that the ability of THC to monopolize the CB1 receptor is part of the reason why it works so well with opioids. The CB1 receptor is responsible for the feelings of euphoria (among other things) caused by opiates and cannabis. There is also an idea that opioid receptors and the CB1 receptor communicate and interact with one another. Although this friendly relationship is still poorly understood, it may be why there is such synergy between cannabis and opioids. Finally, there is also evidence that THC promotes the body’s own opioid response, relieving the need for external opioids.

So in three separate ways, cannabis mitigates the need for high doses of opioids. First, it interacts with the CB1 receptor to boost mood, without the need for additional opioids, perhaps reducing the risk of addiction. Second, because it activates the CB1 receptor, it promotes increased communication to the opioid receptor – a synergistic relationship. Thirdly, it increases the body’s ability to reduce its own pain through naturally increased opioid production.

While researchers continue to get to the bottom of the opioid-cannabis relationship, there is already evidence that cannabis is helping to fight the opioid epidemic in states with legal access to cannabis. It’s still early days, but the statistics strongly suggest that “broader access to medical cannabis facilitates substitution of cannabis for powerful and addictive opioids.”

A study released in 2014 certainly suggests states with legal access to medical cannabis are associated with lower rate of mortality from overdose. The relationship between cannabis regulation and overdose deaths still needs more investigation, yet there may be something to gather from this new study exploring cannabis’s ability to enhance opioids. If patients require lower doses of oxycodone, and cannabis helps to mitigate the risk of addiction, perhaps its why fewer patients are dying. As always, further research is needed to approve these theories and claims.